SCOTUS ruling shows complexity of minors' transgender care

The Supreme Court ruling on Wednesday upholding a Tennessee law that prohibits medical care enabling gender transition for minors — puberty blockers and hormone treatments — has been described not only by activists but by some news media reports as a "blow to transgender Americans." The reality is far more complicated. The law, and similar bans in more than 20 other states, may be too sweeping — but it also reflects serious concerns about potentially harmful procedures for children who are, in many other contexts, regarded as insufficiently mature to make major decisions.

One of the three dissenters, Justice Sonia Sotomayor, accused the court of abandoning "transgender children and their families to political whims." But people who support bans on pediatric gender care see it as a matter of protecting children. Indeed, such bans are broadly popular with the American public: In a 2023 Washington Post/Kaiser Family Foundation poll, 68% opposed puberty-blocking and hormone treatments for minors under 14 while 58% opposed such treatments even for older teenagers under 18.

Nor is this backlash limited to the United States. A number of European countries, including ones known for socially progressive policies such as Sweden and Norway, have moved to restrict puberty-blocking and hormonal treatments for children in recent years. England’s National Health Service has also banned such therapies except in clinical trials. Last year, a report by eminent British pediatrician Dr. Hillary Cass concluded that the benefits of these treatments were uncertain and the potential risks were still unknown.

In the U.S., questions about youth gender transition have been the subject of extremely acrimonious debate for nearly a decade. Some young people have regretted their transitions and reported suffering long-term harm. Some clinic staffers have raised alarms about underage patients being rushed through transition without adequate screening or safeguards.

Meanwhile, journalists and media outlets exploring these issues have often experienced not only strong pressure from activists to back off but, in some cases, troubling harassment and abuse, including violent threats and accusations of complicity in the deaths of transgender kids. Some studies show that transgender-identifying minors who are denied access to medical transition are more likely to have suicidal thoughts; however, there is no evidence that this is correlated with actual suicides.

Blanket bans on transition care for minors are likely too broad; many critics of the overuse of such care agree that it can be appropriate for minors with extreme gender dysphoria. But even some gender therapists such as clinical psychologist Erica Anderson — a transgender woman — have been warning for years about potential abuses of such treatments. Most kids who question their gender identity appear to resolve those issues and settle into an identity consistent with their biological sex. In many cases, those seeking transition have other mental health issues or emotional disorders and may wrongly attribute their distress to being born into the wrong body. Others may embrace a transgender identity as a result of peer pressure.

The failure to address these problems has been real — but in response, the pendulum is likely to swing too far. Today, a backlash on the right threatens even gender transition for adults, with attempts to restrict medical care and deny legal recognition for gender identity different from birth sex. These are disturbing assaults on personal freedoms.

However, states are also within their rights to address potential harm to minors. Activists who want to protect transgender rights need to accept that such concerns are legitimate if they want to regain public support.

Opinions expressed by Cathy Young, a writer for The Bulwark, are her own.

By Cathy Young

Cathy Young is a writer for The Bulwark.